Student Application for AVES Scholarship College_____________________________________________________________

Los Angeles Community College District

Student Information

_______________________________ _____ _____________________________ ____________ ________-______-___________

Last Name M. I. First Date of Birth Social Security Number

__________________________________________________________ ___________________________ ___________ ________________

Address City State Zip Code

(______) ________-______________ (______) ________-______________ _______________________________ Male Female

Phone Number Alternate Phone Number Email Address Gender (optional info)

____________________ ____________________________ _______________________________ ___________________________

College of Enrollment Major Educational Goal (e.g. AA, BA, MBA) Career Goal

Financial Aid

Currently eligible (circle one) Yes No

___________ ____________________________ ______________________ _____________________ _________________________

Current GPA Current # of enrolled units (12 min) Hobbies/Interests

Ethnicity (optional): Asian/ Pacific Islander Black Hispanic/Latino Middle Eastern Native American Caucasian

Highest educational level completed? 9^th grade High School/GED 2 yr. College 4yr College Graduate School Trade School

Area of Study (check all that apply)

Advertising Architecture Art/Graphics Building Trades Business Administration Civil Engineering	Clerical Computer Programming Computer Technology Communications Construction Technology Customer Service Drafting	Education Electronics Engineering Environmental Science Finance Food Service Health and Safety	Human Resources Interior Design Insurance Journalism Language Law/Legal Manufacturing	Marketing Media Mechanics Mechanical Systems Public Relations Political Science Social Science Urban Planning
™ Other (please describe)

School and Community Involvement

School Involvement Position	(Please describe your involvement)
Organization Name of organization	(Please describe your involvement)

Student Signature: ___________________________________________________ Date: _______________________________

Student Name: __________________________________ Social Security Number: ___ ___ ___ ___

(print name clearly) (enter the last 4 digits of your social security number)

Faculty Referral and Recommendation

Faculty First Name: ________________________ Faculty Last Name: __________________________

College: ____________________________ Department: _____________________________________

Faculty Phone Number: ( ) -_____________ Faculty Email: _____________________________

I am referring ____________________________ for an AVES Scholarship.

(Student Name)

Faculty Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature: _______________________________________ Date: ___________________________________

LACCD AVES Scholarship Application

For questions concerning this form please contact Dr. William K. Grevatt, at (213) 891-2433.

Internal Office Use Only